<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Min_amount')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-min_amount" class="form-control" name="row[min_amount]" type="number" value="{$row.min_amount|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Max_amount')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-max_amount" class="form-control" name="row[max_amount]" type="number" value="{$row.max_amount|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fee" class="form-control" name="row[fee]" type="number" value="{$row.fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Tax')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-tax" class="form-control" step="0.01" name="row[tax]" type="number" value="{$row.tax|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
